Advertisement

Pituitary Adenomas: Surgery Perspective

  • William T. Couldwell
  • Martin H. Weiss

Abstract

The first recorded attempt at surgical resection of a pituitary tumor was a two-stage lateral subtemporal decompression in an acromegalic patient performed by Caton and Paul [1]. They used a temporal approach as suggested by Sir Victor Horsley, who later used both a subfrontal approach and a lateral middle fossa approach in operating on 10 pituitary tumors [2]. The first successful removal of a pituitary tumor via a superior nasal transsphenoidal approach was in 1907 (Fig. 27-1) [3]–[5].
Figure 27-1

Schloffer’s transnasal transsphenoidal operation. (A) Incision made along the left nasolabial furrow around the left ala nasi and continued up to the glabella. (B) The incision cuts through the skin, nasal bone, philtrum, and the anterior part of the septum. The whole external nose is reflected to the right exposing the remainder of the septum. (C) The rest of the nasal septum has been removed exposing the rostrum of the sphenoid sinus. (D) The anterior wall of the sphenoid sinus is opened, the mucosal lining of the sinus is removed with a sharp spoon, and the floor of the sella is removed with a small chisel or punch forceps. (From: Cope VZ. The pituitary fossa and the methods of surgical approach thereto. Br J Surg 1916; 4:107–144. Used with permission.)

Keywords

Pituitary Adenoma Pituitary Tumor Cavernous Sinus Sphenoid Sinus Gamma Knife Radiosurgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Caton R, Paul FT. Notes of a case of acromegaly treated by operation. Br Med J 1983;2:1421–1423.CrossRefGoogle Scholar
  2. 2.
    Cope VZ. The pituitary fossa, and the methods of surgical approach thereto. Br J Surg 1916;4:107–144.CrossRefGoogle Scholar
  3. 3.
    Schloffer H. Zur frage der operationen an der hypophyse. Beitr Klin Chir 1906;50:767–817.Google Scholar
  4. 4.
    Schloffer H. Erfolgreiche operation eines hypophysentumor auf nasalem wege. Wien Klin Wochenschr 1907;20:621–624.Google Scholar
  5. 5.
    Schloffer H. Weiterer bericht uber den fall von operiertem hypophysen-tumor. Wien Klin Wochenschr 1907;20:1075–1078.Google Scholar
  6. 6.
    Laws ER Jr. Pituitary surgery. Endocrinol Clin Metab North Am 1987;16:647–665.Google Scholar
  7. 7.
    Ebersold MJ, Quast LM, Laws ER Jr, Scheithauer B, Randall RV. Long term results in transsphenoidal removal of nonfunctioning pituitary adneomas. J Neurosurg 1986;64:713–719.CrossRefPubMedGoogle Scholar
  8. 8.
    Bills DC, Meyer FB, Laws ER Jr, et al. A retrospective analysis of pituitary apoplexy. Neurosurgery 1993;33:602–608.CrossRefPubMedGoogle Scholar
  9. 9.
    Ebersold MJ, Laws ER Jr, Scheithauer BW, et al. Pituitary apoplexy treated by transsphenoidal surgery. J Neurosurg 1983;58:315.CrossRefPubMedGoogle Scholar
  10. 10.
    Laws ER Jr. Transsphenoidal decompression of the optic nerve and chiasm: visual results in 62 patients. J Neurosurg 1977;46:717–722.CrossRefPubMedGoogle Scholar
  11. 11.
    Davis DH, Laws ER Jr, Ilstrup DM, et al. Results of surgical treatment for growth hormone-secreting pituitary adenomas. J Neurosurg 1993;79:70–75.CrossRefPubMedGoogle Scholar
  12. 12.
    Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 1998;89:353–358.CrossRefPubMedGoogle Scholar
  13. 13.
    Laws ER Jr, Piepgras DG, Randall RV, et al. Neurosurgical management of acromegaly. Results in 82 patients treated between 1972 and 1977. J Neurosurg 1979;50:454–4561.CrossRefPubMedGoogle Scholar
  14. 14.
    Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 1988;68:854–867.CrossRefPubMedGoogle Scholar
  15. 15.
    Laws ER Jr, Fode NC, Redmond MJ. Transsphenoidal sur — gery following unsuccessful prior therapy. J Neurosurg 1985;63:823.CrossRefPubMedGoogle Scholar
  16. 16.
    Spencer WR, Levine JM, Couldwell WT, Brown-Wagner M, Moscatello A. Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabial-transsphenoidal approaches. Otolaryngol Head Neck Surg 2000;122:367–369.CrossRefPubMedGoogle Scholar
  17. 17.
    Couldwell WT. Transsphenoidal and transcranial surgery for pituitary adenomas. J Neurooncol 2004;69:237–256.CrossRefPubMedGoogle Scholar
  18. 18.
    Couldwell WT, Weiss MH. The transnasal transsphenoidal approach. In: Apuzzo MLJ, ed. Surgery of the Third Ventricle, 2nd ed. Philadelphia: Williams & Wilkins, 1998:553–574.Google Scholar
  19. 19.
    Liu JK, Weiss MH, Couldwell WT. Surgical approaches to the pituitary gland. Neurosurg Clin N Am 2003;14:93–107.CrossRefPubMedGoogle Scholar
  20. 20.
    Couldwell WT, Kan P, Weiss M. Simple closure following transsphenoidal surgery. Neurosurg Focus 2006;20(3):E11.CrossRefPubMedGoogle Scholar
  21. 21.
    Fraioli B, Esposito V, Santoro A, et al. Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 1995;82:63–69.CrossRefPubMedGoogle Scholar
  22. 22.
    Sabit I, Schaefer SD, Couldwell WT. Extradural extranasal combined transmaxillary transsphenoidal approach to the cavernous sinus: a minimally invasive microsurgical model. Laryngoscope 2000;110:286–291.CrossRefPubMedGoogle Scholar
  23. 23.
    Weiss MH. Transnasal transsphenoidal approach. In: Apuzzo ML, ed. Surgery of the Third Ventricle. Philadelphia: Williams & Wilkins, 1987:476–494.Google Scholar
  24. 24.
    Kouri JG, Chen MY, Watson JC, et al. Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 2000;92:1028–1035.CrossRefPubMedGoogle Scholar
  25. 25.
    Mason RB, Nieman LK, Doppman JL, et al. Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function. J Neurosurg 1997;87:343–351.CrossRefPubMedGoogle Scholar
  26. 26.
    Alfieri A. Endoscopic endonasal transsphenoidal approach to the sellar region: technical evolution of the methodology and refinement of a dedicated instrumentation. J Neurosurg Sci 1999;43:85–92.PubMedGoogle Scholar
  27. 27.
    Cappabianca P, Alfieri A, Thermes S, et al. Instruments for endoscopic endonasal transsphenoidal surgery. Neurosurgery 1999;45:392–396.CrossRefPubMedGoogle Scholar
  28. 28.
    Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997;87:44–51.CrossRefPubMedGoogle Scholar
  29. 29.
    Yaniv E, Rappaport ZH. Endoscopic transseptal transsphenoidal surgery for pituitary tumors. Neurosurgery 1997;40:944–946.CrossRefPubMedGoogle Scholar
  30. 30.
    Jho HD, Carrau RL, Ko Y, et al. Endoscopic pituitary surgery: an early experience. Surg Neurol 1997;47:213–222.CrossRefPubMedGoogle Scholar
  31. 31.
    Spencer WR, Das K, Nwagwu C, et al. Approaches to the sellar and parasellar region: anatomic comparison of the microscope vs. endoscope. Laryngoscope 1999;109:791–794.CrossRefPubMedGoogle Scholar
  32. 32.
    Yasargil MG, ed. Microneurosurgery. Vol. I. Microsurgical anatomy of the basal cisterns and vessels of the brain, diagnostic studies, general operative techniques, and pathological considerations of the intracranial aneurysms. Stuttgart: Georg Thieme Verlag, 1984.Google Scholar
  33. 33.
    Littley MD, Shalet SM, Beardwell CG, et al. Radiation-induced hypopituitarism is dose-dependent. Clin Endocrinol 1989;31:363–373.CrossRefGoogle Scholar
  34. 34.
    Kim MS, Lee SI, Sim JH. Gamma knife radiosurgery for functioning pituitary microadenoma. Stereotact Funct Neurosurg 1999;72(Suppl 1):119–124.CrossRefPubMedGoogle Scholar
  35. 35.
    Kim SH, Huh R, Chang JW, et al. Gamma knife radiosurgery for functioning pituitary adenomas. Stereotact Funct Neurosurg 1999;72(Suppl 1):101–110.CrossRefPubMedGoogle Scholar
  36. 36.
    Kobayashi T, Kida Y, Mori Y. Gamma knife radiosurgery in the treatment of Cushing’s disease: long-term results. J Neurosurg 2002;97(Suppl 5):422–428.PubMedGoogle Scholar
  37. 37.
    Landolt AM, Haller D, Lomax N, et al. Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg 1998;88:1002–1008.CrossRefPubMedGoogle Scholar
  38. 38.
    Landolt AM, Lomax N. Gamma knife radiosurgery for prolactinomas. J Neurosurg 2000;93(Suppl 3):13–18.Google Scholar
  39. 39.
    Pan L, Zhang N, Wang EM, et al. Gamma knife radiosurgery as a primary treatment for prolactinomas. J Neurosurg 2000;93(Suppl 3):10–13.PubMedGoogle Scholar
  40. 40.
    Sheehan JP, Kondziolka D, Flickinger J, et al. Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg 2002;97(Suppl 5):415–421.Google Scholar
  41. 41.
    Shin M, Kurita H, Sasaki T, et al. Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus. J Neurosurg 2000;93(Suppl 3):2–5.PubMedGoogle Scholar
  42. 42.
    Boelaert K, Gittoes NJ. Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinol 2001;144:569–575.CrossRefPubMedGoogle Scholar
  43. 43.
    Tsang RW, Brierley JD, Panzararekka T, et al. Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 1994;30:557–565.PubMedGoogle Scholar
  44. 44.
    Wowra B, Stummer W. Efficacy of gamma knife radiosurgery for nonfunctioning pituitary adenomas: a quantitative follow up with magnetic resonance imaging-based volumetric analysis. J Neurosurg 2002;97(Suppl 5):429–432.PubMedGoogle Scholar
  45. 45.
    Izawa M, Hayashi M, Nakaya K, et al. Gamma knife radiosurgery for pituitary adenomas. J Neurosurg 2000;93(Suppl 3):19–22.PubMedGoogle Scholar
  46. 46.
    Kondziolka D, Flickinger JC, Lunsford LD. Radiation therapy and radiosurgery of pituitary tumors. In: Krisht AF, Tindall GT, eds. Pituitary Disorders: Comprehensive Management. Philadelphia: Lippincott Williams & Wilkins, 1999:407–415.Google Scholar
  47. 47.
    Laws ER Jr, Vance ML. Conventional radiotherapy for pituitary tumors. Neurosurg Clin N Am 2000;11:617–625.PubMedGoogle Scholar
  48. 48.
    Morange-Ramos I, Regis J, Dufour H, et al. Short-term endocrinological results after gamma knife surgery of pituitary adenomas. Stereotact Funct Neurosurg 1998;70:127–138.CrossRefPubMedGoogle Scholar
  49. 49.
    Yoon SC, Suh TS, Jang HS, et al. Clinical results of 24 pituitary macroadenomas with linac-based stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 1998;41:849–853.PubMedGoogle Scholar
  50. 50.
    Liu JK, Schmidt MH, MacDonald JD, Jensen RL, Couldwell WT. Hypophysial transposition (hypophysopexy) for radiosurgical treatment of pituitary tumors involving the cavernous sinus: technical note. Neurosurg Focus 2003;14(5):E11.PubMedGoogle Scholar
  51. 51.
    Couldwell WT, Rosenow JM, Rovit RL, Benzil DL. Hypophysopexy technique for radiosurgical treatment of cavernous sinus pituitary adenoma. Pituitary 2002;5:169–173.CrossRefPubMedGoogle Scholar
  52. 52.
    Liu JK, Das K, Weiss MH, Laws ER, Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg 2001;95:1083–1096.CrossRefPubMedGoogle Scholar
  53. 53.
    Couldwell WT, Weiss MH. Pituitary macroadenomas. In: Apuzzo MLJ, ed. Brain Surgery: Complication Avoidance and Management. New York: Churchill Livingstone, 1993:295–312.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • William T. Couldwell
    • 1
  • Martin H. Weiss
    • 2
    • 3
  1. 1.Department of NeurosurgeryUniversity of UtahSalt Lake CityUSA
  2. 2.Department of Neurological SurgeryUSCUSA
  3. 3.Department of NeurosurgeryUSC University HospitalLos AngelesUSA

Personalised recommendations